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Eight Steps to Help You, Your Children & Your Family Thrive In Quarantine

Some of you are doing well.  Some of you aren’t.   There is a twisted part of some of you that actually like this “shut-down.”  Because, you’ve been in a mental/emotional shut down for years.  The pain of past failures punched holes in your heart.  You feel it and re-experience it when you try.  Your family sees it (they just don’t say anything).  Your friends see it. But, they are tactful and just smile.

With each failure, you lowered the fence.  With each betrayal, you widened the moat around your soul.

And now, life has caught up to you.

Part of you wants to double down and float corpse-like in the misery of the past.  Quarantine is an easy excuse to kill the last spark of your ambition, binge on Netflix and pop bon-bons on the couch.

But, COVID-19 just kicked over the game-board.  Life’s dice have just been changed.

Pull back the curtain of chaos around your life and the life of your family.  Realize that you actually set the rules.

The Eight Rules

There are eight rules that, if applied, will stabilize you and your family.  And, if you teach them to your children, you will solidify a generation.

Give your life and your children some structure.

We as humans have always needed guard rails, or banisters, especially the little humans.  A simple list of the top three things you and your children need to do today will make the day go so much smoother. Start at the top and go to work.  You don’t have to accomplish all three, but, just knowing the three most important things to accomplish today, gives you and your ” miniature carbon copies” satisfying direction.  If you don’t finish number 2 or 3, then put them on the top of the list tomorrow.

Delayed gratification is your true best friend.

This is a perfect time to place strategic rewards on pleasurable activities. I realize that spending the day in your pajamas watching TV, Netflix binge’ng, or playing video games can be very easy.  These activities are fine after the structure has been addressed.  Clean your room, then reward yourself with a video game. Fold the laundry, then surf the internet.  Mow the lawn, then watch Netflix.  Pay the bills, then reward yourself.

People, grown and those still growing, always respond better and gain self-confidence when experiencing delayed gratification.

Teach your family the how and why of working together.

Yes, the shutdown causes problems.  But, make lemon-aid out of lemons.  Teach your family to cook, plan and make meals together (I know a great book with 60 wonderful ketogenic recipes). Young children can clean up, feed the dog, take out the garbage and even do their own laundry.

My wife had our children doing their own laundry at seven years old.  Umm, yes, they actually can, and are capable of some complex chores at that age.  Anyone that can “Call of Duty,” “Super-Mario” or dress a Barbie can sort clothes and turn on a washing machine.  This is a perfect time to teach them and supervise.

Exercise as a family.

Daily family walks, runs, or weight lifting (body-weight exercises if you don’t have weights) will shake out the cobwebs.  Teach your kids great health habits and you fatigue them for bedtime sooner in the process.

Tell your children stories.

Share stories around the dinner table of your adventures, successes and failures.  They want to hear the how and why, it is educational for them and it is therapeutic for you.  Read to your kids before bed.  We worked through the entire Narnia series over a couple years and my kids still talk about it.

Or, better yet, tell them a bedtime story.  The crazier the better. You will never regret it, and it will be some of the most memorable things your family may experience.

Find a project that you and they can tackle.

My daughter loves to collect Medieval swords and loves to sword-fight (Probably because of the bedtime stories we read.)  We had this collection of swords that was hard to keep in a closet.  So, we made a wooden sword rack together.  My daughter found that she “loves to build stuff,” and this  brought out a creative side of her that my wife and I had never seen.

Carve out some adult time. 

You need time for yourself.  You also need time with your spouse.  Kids need to see that adults need some time for themselves.

I can still remember the time when my daughter called me at work in tears.  When I asked what was wrong, she told me, “Mom put herself in time-out, she locked herself in the bedroom and she won’t come out.”

My wife was homeschooling the kids, it had been a difficult year and didn’t give herself time to regroup.  She was frazzled.   To this day, my grown children and I have learned that each of us needs some personal time.  Or, we end up putting ourselves in “time-out.”

Learn and teach your family independence. 

If your family, your spouse, or those you are responsible for come to you with every little unmet need and want, this quarantine is going to  feel like it “lasts for years!” Train your family, and yourself, up front what they can do for themselves. And, teach them how to decide when they can do it on their own.  Help them be independent.  Tears and whining will probably occur, initially (probably, from your husband the most.) But, it is our job to take completely dependent infants and turn them into independent self-starting adults within 18 years.

So, dream big, take your white knuckles off the steering wheel, pull over and re-imagine your life.  These eight rules are the alchemy of the soul.

The Shovel will Fail You in Obesity, Finances & Life

A few years ago, my family and I set out to build a pond.

I have always loved Koi and the serenity of a Koi pond in my own back yard was very enticing. I spent about a year planning my design and the location.  I dreamed of a serene evening after a very long, hectic day seeing patients relaxing beside the pond.  The sound of trickling water, the occasional splash from fish, the cool breeze passing over the mist from a water-fall would sooth my soul after a busy day in the office.

I envisioned the perfect area.  An unused access path, previously worn by the previous owner with truck and trailer traffic, beside my now expanded patio. Twenty feet wide, thirty feet long and four feet deep. . . that seems just perfect.

I pulled out my shovel and set about digging. Eager to begin and filled with the energy of the final product, I set to digging.  What could be so hard about digging my own pond?  Think of the exercise I will be getting.  Thoughts spurred me on.

Minutes later, chest heaving, face glistening with sweat, I stared in dismay at the ground. All I had to show for my wild digging was a small 1/2 inch dent in the dusty Arizona top soil.

Sonoran Clay

Over time, calcium-carbonate, along with other minerals, accumulates and dissolves into the topsoil of the very arid regions of Arizona Sonoran Desert.  It forms a two to three-foot layer of soil called “caliche.” Periodic rains carry the calcium as far as three feet down into the soil, then the water rapidly evaporates in the blistering Arizona heat.  This often forms two to three feet of soil that is “literally” harder than concrete.

With tremendous zeal, a great deal of sweat and a round of painful blisters, I broke my third shovel on this impenetrable ground.  I realized this was much more difficult than I thought.  I pulled out the back-hoe attachment for my small farm tractor.  After a few hours and few gallons of diesel fuel later, still very little progress occurred.

Multiple weekends and evenings of digging in the Arizona caliche left me with three broken shovels, a ruptured hydrolic line in my tractor, anger that my expensive back-hoe attachment didn’t work, and only a small dent in the ground near my patio.  Even the brute force from the tractor would not budge the clay.  I wondered if dynamite would be effective?  (My wife would have none of this idea).

With my exuberance quashed, I concluded that this would require much more measured exhuming.

Escape From the Prison

We often imagine, with great delight, the removal or destruction of that which enslaves or imprisons us.  We dream that just a little sweat, exertion of a few shovel scoops of dirt and the foundation to our prison of obesity, addiction, debt, and depression are exposed.  A few extra scoops and we imagine freedom from that prison cell.

If only I had a jack hammer and a bigger, more powerful scoop, I imagine . . . I could make short work of these manacles that bind me.

But, our manacles and prison cells do not so easily give way.

The failings of our sharpened spades and powerful back-hoes form a new, even stronger fetter – the belief that our prison cell is unbreakable, that our challenge is just too great. These failings usually leave a person cured of any further desire to break free.  It quashs the dream and solidifying the depression of stagnation.

The in-fecundity of my shovel, no matter the strength and effort put behind it, was not cause to quit.  It was life’s lesson that prisons and shackles often only need a simple tool.

Enter the pick-axe.  During this process my wife said, “Honey, why don’t you use the pick in the garage?”

“If my shovel and the back-hoe didn’t work, there was no way I was going to break through this clay with a pick axe.” That was absurd, I thought.

Yet when I humbled myself to try, it was simple.  The pick-axe was unpretentious.  This simple tool allowed for an almost effortless stroke to a small area of weakness in the caliche.  A large flake of soil would pop free with each stroke. The process was repeated.

Scale by scale, the dragon’s flank was exposed. Careful work of the pick-axe began to loosen layer after layer, section after section, pellicle after pellicle.  Yes, it was slow work. But, each swing was a small victory.

At each little victory, my heart would leap, the dream would become ever clearer.

Working this magic again and again until finally the specter was weakened enough to pull out the shovel.  And, further work, allowed for bringing back the powerful back-hoe, in gratifying scoops.

The excavation that I thought would take two months took me fourteen.  But, it was gratifying.

I learned a powerful lesson. Wherever life has pinned you, fettered you or barred you in, put down the shovel, and pick up the pick-axe.  Second, if you really listen, your spouse may point out the tool you really need. Don’t be afraid to chip away at it a piece at a time.

Finances

Stop waiting for the sharper shovel or the bigger back-hoe to dig yourself out of your harrowing debt, mega mortgage, or your income dwarfing spending. The jackpot or financial windfall won’t come. While others await the jackpot, put down your shovel and shoulder your pick-axe.

  1. Pick one small debt and begin to pick at it by applying just a little extra each month until it is gone.
  2. Cancel your extra cable, sell the motorcycle and payoff the 21% interest credit card.
  3. If you must, pick up a side-hustle for extra to sharpen the pick.

Once you’ve lifted one flake, chip away at the next. Making progress will make it easier to continue.  It doesn’t matter how long it takes, just keep at it.

Marriage

You long for resolution of the apathy, progressive resentment and mutual stalemate that permeates your relationship.  You look in vain for the bigger shovel that will uncover the treasure that years of apathy have buried. You long to uncover your dreams and needs that have been covered and hardened under the clay of resentment.  The shovel and the back-hoe won’t help you here.

Drop the shovel.  Shoulder your pick-axe.

  1. Kiss your wife every time you leave, even if it’s just for a ten minutes to run to the convenience store.
  2. Hold her for five seconds longer every time you hug.
  3. Find a gift you can give her once a week, just because.
  4. Put down your phone and look her in the eyes when she talks to you and listen. Really listen and the flakes of hard clay will unveil the beauty of her soul.
  5. Find a way to praise her every day, even if it is through a simple text.

Health

You long to rid yourself of your addiction to sugar, bread, stress, and sleep deprivation.  You’ve tried to scoop them out of your life.  You even hired a trainer with some muscle to force you to change.  You’ve tried in vain to save yourself from yourself.

Trying to use the shovel here is like trying to use the shovel on steel forged walls of your life’s prison fortress.  Forget the shovel.  Shoulder your pick-axe.

  1. Start with one meal and make some substitutions.  My dietary plan can help you with this.
  2. Go to bed an hour earlier. Really, you’ll be surprised that the focus you have will more than compensate for the hour of lost time in the evening.
  3. Add a quality vitamin to your morning routine.
  4. Take ten minutes and do 20 push-ups and 20 sit-ups, then take a 10-minute walk.
  5. Simply remove the “white stuff” from your meals. You will be amazed at the results.
  6. Put down your phone for 30 minutes and read that book you’ve been meaning to read, instead of surfing Facebook.

Grand-standing with your back-hoe doesn’t help you.  Just swing the pick-axe once or twice.  Simple daily picking with the sharp point weakens the hardest of ground and the prison walls in our lives.  It takes time, so be patient.

Find the weak point, apply the pick.  Day by day, little by little you will be free.

I’ve been there.  I’m with you.  Keep me posted on your journey.

If you’re looking for a program that teaches you how to do this, check out my membership site.

What Are Your Biggest Weight Loss Struggles?

Join Dr. Nally on this evening’s Periscope as we talk about your biggest weight loss struggles in rapid fire style.  We cover topics this evening from the effects of cheating on a ketogenic diet to how to overcome a weight loss stall . . . join us to hear the whole conversation.

Today’s Weight Loss Rx . . .

A few of my patients have recently asked me, “Dr. Nally, why to you post pictures of your horsekoi and farm animals on instagram?”

Let me answer that question with the following questions:

  • Do you find yourself longing for the apocalypse?
  • Do you find yourself looking for a reason to live?
  • Are you feeling tired, irritable, stressed out?
  • Do you or you family find yourself to be overly cynical, jaded or emotionally numb?

If you can answer “yes” to any of the questions above, then I highly recommend prescription strength nature . . .

All parody and humor aside, full strength prescription nature is one of the very best treatments for stress.

I find that sitting outside with my animals, watching the birds, dogs, horses and ducks dramatically helps with lowering my stress levels and helps me re-focus.  You can see my favorite place to sit on my farm and watch nature . . . here on Katch.me

You may find the following posts very insightful in explaining how stress wreaks havoc on your weight loss, mood & emotions and how to go about fixing it:

For someone like me, who spends 14-18 hours a day taking care of illness and sickness, I have found that spending time in nature is often more therapeutic than any pill available in the pharmacy.  So, this afternoon, if your looking for me, I’ll be taking my own medicine, a prescription of Nature Rx on my horse.

Caffeine . . . Weight Loss Wonder Boy or Sneaky Scoundrel?

I’ve been looking for the answer for quite some time. . . what role does caffeine play in your and my weight management journey?  The answer gave me a headache. . . literally and figuratively.

As many of you, including my office staff, know, I love my Diet Dr. Pepper (and my bacon).  I found that being able to sip on a little soda throughout the day significantly helped the carbohydrate cravings and munchies during a busy and stressful day at the office.   Diet Dr. Pepper contains caffeine, however, I wasn’t really worried.  Caffeine has been well know to have a thermogenic effect which increases your metabolism and has been thought for many years to help with weight loss among the weight loss community.

Diet Dr. Pepper is, also, one of only four diet sodas on the grocery store shelves that doesn’t contain acesulfame potassium (click here to see why most artificial sweeteners cause weight gain).  The four diet sodas that I have been comfortable with my patients using are Diet Dr. Pepper, Diet Coke, Diet Mug Root-beer and Diet A&W Cream Soda.  These are the last four hold out diet sodas that still use NutraSweet (aspartame) as the sweetener.  Most of the soda companies have switched the sweetener in their diet sodas to the insulinogenic acesulfame potassium because it tastes more natural and aspartame has been given a media black eye of late.  However, NutraSweet (aspartame) is the only sweetener that doesn’t spike your insulin or raise blood sugar (click here to find out why that is important).

Yes, I know.  The ingestion of 600 times the approved amount of aspartame causes blindness in lab rats (but we’re not lab rats, and . . . have you ever met someone that drinks 600 Diet Dr. Peppers in a day?  The lethal dose of bananas, which are high in potassium that will stop your heart, is 400).  Aspartame can also exacerbate headaches in some (about 5% of people) and I’ve had a few patients with amplified fibromyalgia symptoms when they use aspartame.   But for most of us, its a useful sweetener that doesn’t spike your insulin response, halting or causing weight gain.

But, over the last few years, I’ve noticed that increased amounts of Diet Dr. Pepper & Diet Coke seem to cause plateauing of weight and decreasing the ability to shift into ketosis, especially mine.  I’ve also noticed (in my personal n=1 experimentation) that my ability to fast after using caffeine regularly seems to be less tolerable, causing headaches and fatigue 8-10 hours into the fast, symptoms that don’t seem to let up until eating. Through the process of elimination, caffeine seems to be the culprit.

Red Bull in caffeineAfter mulling through the last 10 years of caffeine research, most of which were small studies, had mixed results, used coffee as the caffeine delivery system (coffee has over 50 trace minerals that has the potential to skew the results based on the brand) and never seemed to ask the right questions, the ink from a study in the August 2004 Diabetes Care Journal screamed for my attention.

It appears that caffeine actually stimulates a glucose and insulin response through a secondary mechanism.   The insulin surge and glucose response is dramatically amplified in patients who are insulin resistant.  Caffeine doesn’t effect glucose or insulin if taken while fasting; however, when taken with a meal, glucose responses are 21% higher than normal, and insulin responses are 48% higher in the insulin resistant patient. Caffeine seems to only effect the postprandial (2 hours after a meal) glucose and insulin levels.  The literature shows mixed responses in patients when caffeine is in coffee or tea, probably due to the effect of other organic compounds (1).

Caffeine Effect on glucose insulin
Caffeine effect on plasma glucose and plasma insulin compared to placebo (1).

Caffeine also diminishes insulin sensitivity and impairs glucose tolerance in normal and already insulin resistant and/or obese patients.  This is seen most prominently in patients with diabetes mellitus type II (stage IV insulin resistance).  Caffeine causes alterations in glucose homeostasis by decreasing glucose uptake into skeletal muscle, thereby causing elevations in blood glucose concentration and causing an insulin release (2-6).

Studies show that caffeine causes a five fold increase in epinephrine and a smaller, but significant, norepinephrine release.  The diminished insulin sensitivity and exaggerated insulin response appears to be mediated by a catacholamine (epinephrine, norepinephrine & dopamine)  induced stress response (5).  Caffeine has a half life of about 6 hours, that means the caffeine in your system could cause a catacholamine response for up to 72 hours depending upon the amount of caffeine you ingest (7).

The reason for my, and other patient’s, headaches and fatigue after a short fast was due to the exaggerated stress hormone response.  Increased levels of insulin were induced by a catacholamine cascade after caffeine ingestion with a meal, dramatically more amplified in a person like me with insulin resistance. The caffeine with the last meal cause hypoglycemia 5-7 hours into the fasting, leading to headaches and fatigue that are only alleviated by eating.

Even when not fasting, the caffeine induced catacholamine cascade causes up to 48% more insulin release with a meal, halting weight loss and in some cases, causing weight gain.

Caffeine is not the “Wonder-Boy” we thought it was.

How much caffeine will cause these symptoms? 50 mg or more per day can have these effects.

caffeine-content-of-popular-drinks

Ingestion of caffeine has the following effects:

  • 20-40 mg – increased mental clarity for 2-6 hours
  • 50-100 mg – decreased mental clarity, confusion, catacholamine response
  • 250-700 mg – anxiety, nervousness, hypertension & insomnia
  • 500 mg – relaxation of internal anal sphincter tone (yes . . . you begin to soil yourself)
  • 1000 mg – tachycardia, heart palpitations, insomnia, tinnitus, cognitive difficulty.
  • 10,000 mg (10 grams) – lethal dose (Yes, 25 cups of Starbucks Coffee can kill you)

The equivalent of 100 mg of in a human was given to a spider, you can see the very interesting effect on productivity.  How often does the productivity of the day feel like the image below?

Spider Normal
Normal Spider (9)
Spider Caffeine
Spider on caffeine (9)

Beware that caffeine is now being added to a number of skin care products including wrinkle creams and makeup.  Yes, caffeine is absorbed through the skin, so check the ingredients on your skin care products.

Diet Dr. Pepper, my caffeine delivery system of choice, has slightly less caffeine (39 mg per 12 oz can or 3.25 mg per oz) than regular Dr. Pepper.  I found myself drinking 2-3 liters of Diet Dr. Pepper per day (long 16-18 hour work days in the office).  After doing my research, I realized that my caffeine tolerance had built up to quite a significant level (230-350 grams per day).

So, a few weeks ago, I quit . . . cold turkey.

Did I mention the 15 withdrawal symptoms of caffeine? (8)

  • Headache – behind the eyes to the back of the head
  • Sleepiness – can’t keep your eyes open kind of sleepiness
  • Irritability – everyone around you thinks you’ve become a bear
  • Lethargy – feels like your wearing a 70 lb lead vest
  • Constipation – do I really need to explain this one?
  • Depression – you may actually feel like giving up on life
  • Muscle Pain, Stiffness, Cramping – feel like you were run over by a train
  • Lack of Concentration – don’t plan on studying, doing your taxes or performing brain surgery during this period
  • Flu Like Illness – sinus pressure and stuffiness that just won’t clear
  • Insomnia – you feel sleepy, but you can’t sleep
  • Nausea & Vomiting – You may loose your appetite
  • Anxiety – amplified panic attacks or feeling like the sky is falling
  • Brain Fog – can’t hold coherent thoughts or difficulty with common tasks
  • Dizziness – your sense of equilibrium may be off
  • Low Blood Pressure & Heart Palpitations – low pressure and abnormal heart rhythm

I experienced 13 of the 15 that lasted for 4 days.   I do not recommend quitting cold turkey unless you have a week off and someone to hold your hand, cook your meals and dose your Tylenol or Motrin.  My wife thought I was dying. . . I thought I was dying on day two.  I actually had a nightmare about buying and getting into my own coffin.  It can take up to three weeks to completely recover from caffeine withdrawal.

The other way to quit is to decrease your caffeine intake by 50 mg every two days.   That means decrease caffeine by:

  • 1 can of soda every two days
  • 1/4 cup of coffee every day
  • 1/2 can of Energy Drinks every two days
  • 1 cup of tea every two days

The benefit of this method is that withdrawal symptoms are much less severe without the caffeine headache and the ability to remain productive.  It will take longer, but quitting cold turkey is not a pretty picture.  Been there . . . done that, . . . and I’m not going back. I actually lost another half inch off my waistline by day 5 of caffeine discontinuation.

What is the take home message here?  If you have any degree of insulin resistance, caffeine makes it worse and will amplify your weight gain as well as decrease the productivity of your day.

References:

  1. Lane JD, Barkauskas CE Surwit RS, Feinglos MN, Caffeine Impairs Glucose Metabolism in Type II Diabetes, Diabetes Care August 2004 vol. 27 no. 8 2047-2048; doi:10.2337/diacare.27.8.204
  2. Jankelson OM, Beaser SB, Howard FM, Mayer J: Effect of coffee on glucose tolerance and circulating insulin in men with maturity-onset diabetes. Lancet 1527–529, 1967
  3. Graham TE, Sathasivam P, Rowland M, Marko N, Greer F, Battram D: Caffeine ingestion elevates plasma insulin response in humans during an oral glucose tolerance test. Can J Physiol Pharmacol 79:559–565, 2001
  4. Greer F, Hudson R, Ross R, Graham T: Caffeine ingestion decreases glucose disposal during a hyperinsulinemic-euglycemic clamp in sedentary humans.Diabetes 50:2349–2354, 2001
  5. Keijzers GB, De Galan BE, Tack CJ, Smits P: Caffeine can decrease insulin sensitivity in humans. Diabetes Care 25:364–369, 2002
  6. Petrie HJ, et al. Caffeine ingestion increases the insulin response to an oral-glucose-tolerance test in obese men before and after weight loss. American Society for Clinical Nutrition. 80:22-28, 2004
  7. Evans SM, Griffiths RR, Caffeine Withdrawal: A Parametric Analysis of Caffeine Dosing Conditions, JPET April 1, 1999 vol. 289no. 1 285-294
  8. Noever R, Cronise J, Relwani RA. Using spider-web patterns to determine toxicity. NASA Tech Briefs April 29,1995. 19(4):82. Published in New Scientist magazine, 29 April 1995

Adrenal Insufficiency, Adrenal Fatigue, PseudoCushing’s Syndrome – Oh My!

Adrenal Fatigue? Adrenal Insufficiency?  Cortisol? PseudoCushing’s Syndrome?  What do these terms mean and why are they all over the internet these days? And, what do they have to do with your weight loss?

This was our topic this evening on PeriScope.  Katch Dr. Nally speak about this topic with rolling comments at Katch.me/docmuscles.  Or you can watch the video below:

If you’re not sure about what this is, you’re not alone. I think I’ve heard the term “Adrenal Fatigue” at lease four times a day for the last three months.  If you ask your doctor, they’ll probably scratch their heads too.  The funny thing is that “Adrenal Fatigue” isn’t a real diagnosis, but it is all over the internet and it shows up in the titles of magazines in the grocery store every day.  There’s even and “Adrenal Fatigue For Dummies” so it must be real, right?!  Adrenal Fatigue for Dummies

No.  It isn’t a real diagnosis.  It is a conglomeration of symptoms including fatigue, difficulty getting out of bed in the morning, and “brain fog” that have been lumped together to sell an “adrenal supplement.” (Sorry, but that’s really what it is all about.)  Do a Google search and the first five or six sites describing adrenal fatigue claim the solution is taking their “special adrenal supplement.”

I know what you’re thinking, “Your just a main stream, Western Medicine doctor, Dr. Nally, you wouldn’t understand.”  Actually, I do understand.

Adrenal fatigue has risen in popularity as a “lay diagnosis” because many patients show up at their doctors office with significant symptoms that actually interfere with their ability to function, and after all the testing comes back negative for any significant illness, they are told that they are normal.  But the patient still has the symptoms and no answer or treatment has been offered.  It’s discouraging. . . very discouraging.

That’s because the symptoms are actually the body’s response to chronic long term stress.  Many of my patients, myself included, have found themselves “stuck” in their weight loss progression, feeling fatigued, struggling to face the day, with a number of symptoms including cold intolerance, memory decline, difficulty concentrating, depression, anxiety, dry skin, hair loss, and even infertility in some cases.  Is it poor functioning adrenal glands? No, your feeling this way because the adrenal glands are actually doing their job!!

If the adrenal glands weren’t working you’d experience darkening of the skin, weight loss, gastric distress, significant weakness, anorexia, low blood pressure, and low blood sugar.  The symptoms are actually called Addison’s disease and it is actually fairly rare (1 in 100,000 chance to be exact).  So what is causing the symptoms you ask?

There are a number of reasons, but one that I am seeing more and more frequently is “Pseudo-Cushings’s Syndrome.Pseudo-Cushing’s Syndrome is a physiologic hypercortisolism (over production of cortisol) that can be caused by five common issues:

  1. Chronic Physical Stress
  2. Severe Bacterial or Fungal Infections that Go Untreated
  3. Malnutrition or Intense Chronic Exercise
  4. Psychological Stress – including untreated or under-treated depression, anxiety, post-traumatic stress, or dysthymia (chronic melancholy)
  5. Alcoholism

The psychiatric literature suggest that up to 80% of people with depressive disorders have increased cortisol secretion (1,2,3).  HPA Stress responsePeople with significant stressors in their life have been show to have an increased corsiol secretion. Chronic stress induces hyperactivity of the hypothalamic-pituitary-adrenal axis causing a daily, cyclic over production of cortisol and then normalization of cortisol after resolution of the stressor.  This cortisol response is not high enough to lead to a true Cushing’s Syndrome, but has the effect of the symptoms listed above and begins with limiting ones ability to loose weight.

I’m convinced that this is becoming more and more prevalent due to the high paced, high-stress, always on, plugged in, 24 hour information overload lives we live.

What is cortisol? It is a steroid hormone made naturally in the body by the adrenal cortex (outer portion of the adrenal gland). Cortisol is normally stimulated by a number of daily activities including fasting, awakening from sleep, exercise, and normal stresses upon the body. Cortisol release into the blood stream is highest in the morning, helping to wake us up, and tapers into the afternoon. Cortisol plays a very important role in helping our bodies to regulate the correct type (carbohydrate, fat, or protein) and amount of fuel to meet the bodies physiologic demands that are placed upon it at a given time (4,5,6).

HPAThyroidUnder a stress response, cortisol turns on gluconeogensis in the liver (the conversion of amino acids or proteins into glucose) for fuel. Cortisol, also, shifts the storage of fats into the deeper abdominal tissues (by stimulating insulin production) and turns on the maturation process of adipocytes (it makes your fat cells age – nothing like having old fat cells, right?!)  In the process, cortisol suppresses the immune system through an inhibitory effect designed to decrease inflammation during times of stress (7,8,9).  If this was only occurring once in a while, this cascade of hormones acts as an important process.  However, when cortisol production is chronically turned up, it leads to abnormal deposition of fat (weight gain), increased risk of infection, impotence, abnormal blood sugars, brain fog, head
aches, hypertension, depression, anxiety, hair loss, dry skin and ankle edema, to name a few.

The chronic elevation in cortisol directly stimulates increased insulin formation by increasing the production of glucose in the body, and cortisol actually blunts or block-aids the thyroid function axis. Both of these actions halt the ability to loose weight, and drive weight gain.
Cortisol also increases appetite (10).  That’s why many people get significant food cravings when they are under stress (“stress eaters”). Cortisol also indirectly affects the other neuro-hormones of the brain including CRH (corticotrophin releasing hormone), leptin, and neuropeptide Y (NPY). High levels of NPY and CRH and reduced levels of leptin have also been shown to stimulate appetite and cause weight gain (10-11).

How do you test for Pseudo-Cushing’s Syndrome?  

Testing can be done by your doctor with a simple morning blood test for cortisol. If your cortisol is found to be elevated, it needs to be repeated with an additional 24 hour urine cortisol measurement to confirm the diagnosis. If Cushing’s Syndrome is suspected, some additional blood testing and diagnostic imaging will be necessary.  Pseudo-Cushing syndrome will demonstrate a slightly elevated morning cortisol that doesn’t meet the criteria for true Cushing’s type syndrome or disease.

How do you treat it?

First, the stressor must be identified and removed.  Are you getting enough sleep?  Is there an underlying infection? Is there untreated anxiety or depression present?  Are you over-exercising?  These things must be addressed.

Second, underlying depression or anxiety can be treated with counseling, a variety of weight neutral anti-depressant medications or a combination of both.  Many of my patients find that meditation, prayer, and journaling are tremendous helps to overcoming much of the anxiety and depression they experience.

Third, adequate sleep is essential.  Remove the television, computer, cell phone, iPad or other electronic distraction from the bedroom.  Go to bed at the same time and get up at the same time each day. Give yourself time each day away from being plugged in, logged in or on-line.

Fourth, mild intensity (40% of your maximal exertion level) exercise 2-3 days a week was found to lower cortisol; however, moderate intensity (60% of your maximal exertion level) to high intensity (80% of your maximal exertion level) exercise was found to raise it (12).  A simple 20 minute walk, 2-3 times per week is very effective.  Find a hobby that you enjoy and participate in it once or twice a week.  Preferably, a hobby that requires some physical activity. The activity will actually help the sleep wake cycles to improve.

Fifth, follow a low carbohydrate or ketogenic diet.  Ketogenic diets decrease insulin and reverse the effect of long term cortisol production.  Ketogenic diets a have also been shown to decrease or mitigate inflammation by reducing hyperinsulinemia commonly present in these patients (13).

So, the take home message is . . . take your adrenal glands off of overdrive.

References:

  1. Pfohl B, Sherman B, Schlechte J, Winokur G. Differences in plasma ACTH and cortisol between depressed patients and normal controls. Biol Psychiatry 1985; 20:1055.
  2. Pfohl B, Sherman B, Schlechte J, Stone R. Pituitary-adrenal axis rhythm disturbances in psychiatric depression. Arch Gen Psychiatry 1985; 42:897.
  3. Gold PW, Loriaux DL, Roy A, et al. Responses to corticotropin-releasing hormone in the hypercortisolism of depression and Cushing’s disease. Pathophysiologic and diagnostic implications. N Engl J Med 1986; 314:1329.
  4. Ely, D.L. Organization of cardiovascular and neurohumoral responses to stress: implications for health and disease. Annals of the New York Academy of Sciences (Reprinted from Stress) 771:594-608, 1995.
  5. McEwen, B.S. The brain as a target of endocrine hormones. In Neuroendocrinology. Krieger and Hughs, Eds.: 33-42. Sinauer Association, Inc., Massachusetts, 1980.
  6. Vicennati, V., L. Ceroni, L. Gagliardi, et al. Response of the hypothalamic- pituitary-adrenocortical axis to high-protein/fat and high carbohydrate meals in women with different obesity phenotypes. The Journal of Clinical Endocrinology and Metabolism 87(8) 3984-3988, 2002.
  7. Wallerius, S., R. Rosmond, T. Ljung, et al. Rise in morning saliva cortisol is associated with abdominal obesity in men: a preliminary report. Journal of Endocrinology Investigation 26: 616-619, 2003.
  8. Epel, E.S., B. McEwen, T. Seeman, et al. Stress and body shape: stress-induced cortisol secretion is consistently greater among women with central fat.
    Psychosomatic Medicine 62:623-632, 2000.
  9. Tomlinson, J.W. & P.M. Stewart. The functional consequences of 11_- hydroxysteroid dehydrogenase expression in adipose tissue. Hormone and Metabolism Research 34: 746-751, 2002.
  10. Epel, E., R. Lapidus, B. McEwen, et al. Stress may add bite to appetite in women: a laboratory study of stress-induced cortisol and eating behavior.Psychoneuroendocrinology 26: 37-49, 2001.
  11. Cavagnini, F., M. Croci, P. Putignano, et al. Glucocorticoids and neuroendocrine function. International Journal of Obesity 24: S77-S79, 2000.
  12. Hill EE, Zack E, Battaglini C, Viru M, Vuru A, Hackney AC. Exercise and circulating cortisol levels: the intensity threshold effect. J Endocrinol Invest. 2008. Jul;31(7):587-91.
  13. Fishel MA et al., Hyperinsulinemia Provokes Synchronous Increases in Central Inflammation and β-Amyloid in Normal Adults. Arch Neurol. 2005;62(10):1539-1544. doi:10.1001/archneur.62.10.noc50112.

Aquaponics Koi & Duck Pond . . . Amazingly Clear Water – A Ketogenic Gardener's Dream

This aquaponics stuff is amazing!  Came home today to crystal clear water.  Even with 9 ducks and 11 fish in the pond, the two lightly planted grow beds and the bogs have cleared up the water with amazing speed.  The algae has disappeared even in direct sunlight and temperatures in the 112-114 degree range over the last week.

IMG_1760

So, in celebration of nature attaining pond water clarity in just two weeks, I added three more beautiful Koi.

It is fascinating how very calming it is to my soul to sit by the pond and watch the ducks & fish.  It appears that a nearby hive of bees is using the pond for a water supply as there is always at lease 5-10 little honey bees driking at the water’s edge.  I’ve seen dragon flies come by daily.  What amazes me is that I’ve now seen more hummingbirds, cardinals and wrens in the last week than I’ve seen all year.  My dogs love it and in the 114 degree weather, wading your feet in the water is so very refreshing.

You can see the progress of this pond over the last 9 months here at The Doc & The Horse.

Now to begin planting my leafy green veggies . . .

The Gateway Called Death

The life of a close friend and patient was recently taken. This has been weighing upon my mind of late, as a similar event occurred in the life of my sister a few years ago.  I looked over the words and passages I wrote a few years ago, and for some reason, felt strongly that I should include them here.  I write this blog to help those struggling with weight, diabetes and the diseases of civilization.  One of those diseases frequently affecting weight is the depression and fear that accompanies the death of a loved one.  Often, the answers science offers are not enough and we are required to rely upon our faith.  I share some of that with you here.

I have spent the majority of my professional life in the acquisition of knowledge and its application in the relief of significant illness.  My greatest foes have been ignorance, disease, distress, disability and, ultimately, death.  I come in contact almost daily with seriously ill patients facing the very real prospect of death.  Of necessity, I have come to look upon death as a formidable foe to be fought.  For all conscientious doctors, death’s gateway from life threatens us as the prospect of individual defeat.

The famed scientist Madame Marie Curie returned to her home the night of the funeral of her husband, Pierre Curie, who was killed in an accident in the streets of Paris.  She made this entry in her diary:

“They filled the grave and put sheaves of flowers on it. Everything is over. Pierre is sleeping his last sleep beneath the earth. It is the end of everything, everything, everything.”

GatewayBUT IS IT?

What is this thing that men call death,
This quiet passing in the night?
Tis not the end, But Genesis
Of better worlds and greater light.
O God, touch though my aching heart,
And calm my troubled, haunting fears.
Let hope and faith, transcendent pure,
Give strength and peace beyond my tears.
There is not death, but only change
With recompense for won;
The gift of Him who loved all men,
The Son of God, the Holy One.
(G. B. Hinckley)

However, every patient of every doctor, if followed long enough will pass away. The first rule of surgery is that “all bleeding stops eventually.” The inescapable rule of life is that no matter how good your treatments are, all patient’s will meet the undertaker, eventually.
When this happens, and it happens to all of us, a sense of sadness naturally prevails regardless of the age or nature of the deceased.

If death is to happen to all of us, then why do we feel sadness at the death of a friend or loved one?

This sadness is caused by the feeling of loss tied to three age-old unanswered questions:

  1. Did you and I exist before we were born, and if so, where were we?
  2. Why are we here together and what is the purpose of this life?
  3. Where do we go when we die?

Are there answers to these questions?

When science does not have the answers, I have found great hope and answers in hidden within the teachings of my faith. I share them with you, not to preach or offend, but in hopes that you might find peace and solace in your life as I have in mine.

The spiritual leader Wilford Woodruff said “that if the people knew what was behind the veil, they would try by every means . . . that they might get there, but the Lord in his wisdom has implanted the fear of death in every person that they might cling to life and thus accomplish the designs of their creator.” (The Gateway We Call Death, Russell M. Nelson, p.96)

The Lord explained to Moses, “For this is my work and my glory, to bring to pass the immortality and eternal life of man.” (Moses 1:39)

This work and glory is referred to by a number of names including The Plan of Salvation, The Plan of Redemption, The Plan of Eternal Progression, The Plan of Happiness and others.

I often speak with people that say to me, “I just want to be happy.” Or they question me asking, “Will I ever really be happy?”

Happiness is the object and design of our existence . . . and well be the end thereof if we pursue the path that leads to it.  Along this path lies virtue, uprightness, faithfulness, holiness and keeping the commands of our Creator.  So how does this help us find happiness in the face of the death of a friend or loved one?

The answers are found in contemplation of the the three age-old questions.  First, where were we before we were born?

The Old Testament prophet Job, one of the more ancient writers of the Bible, gives us some insight. The Lord asked him the same question: “Who is this that darkeneth counsel by words without knowledge? Gird up now thy loins like a man; for I will demand of thee, and answer thou me. Where was thou when I laid the foundation of the earth . . . when the morning stars sang together, and all the sons of God shouted for joy?” (Job 38:2-7)

You and I must have been somewhere – the Lord asked us where we were. And, who were all the “sons of God shouting for joy?” Why were they shouting? Where were they?

The apostle, Luke, in the New Testament answers those questions years later as he lays out the genealogy of the human family.  He starts at Christ and then names each subsequent father leading up to ” . . . Enos, which is the son of Seth, which was the son of Adam, which was the son of God.” (Luke 3:38)

The apostle, John, must have had some idea of a pre-mortal existence because of the way they phrased the question to Jesus Christ about the man who was born blind, “Master, who did sin, this man or his parents, that he was born blind?” (John 9:2) The question was not “could he have sinned before he was born?” but instead, “who did sin?” Christ’s answer implied that both were possible, but neither was the case in this situation.

Paul writes to the Hebrews, “Furthermore, we have had fathers of our flesh which corrected us, and we gave them reverence; shall we not much rather be in subjection to the Father of our Spirits, and live?” (Hebrews 12:9) We are also given instruction to open our prayers with a phrase like, “Our Father in Heaven.” Hence, He is the Father of our Spirits, our Heavenly Father, our spiritual Father.

We then are brothers & sisters in the spiritual sense, and Jesus Christ is our elder brother, being the firstborn spirit child of God.  If this is the case, then all of us, including you and I, were among the sons and daughters of God who shouted for joy along with Adam.

The Lord explained to Moses, “I have created all things, of which I have spoken, spiritually before they were naturally upon the face of the earth . . . for in heaven created I them.” (Moses 3:5) In addition to this, we learn from Moses that a council was held in heaven in which you and I were present. At this grand council, the plan to create this earth, including the fall of Adam, and the Atonement of Jesus Christ was presented and accepted.

There was, however, someone who opposed this plan. Lucifer rebelled and was cast out of heaven with those who chose to follow him.

If all this is true, then it means you and I accepted this plan and here we are. Accepting this plan as described by the prophet Abraham is defined as accepting our First Estate.

So, the first question is where did we come from? We came from the presence of God, the pre-mortal spirit world, in the company of all our spirit brothers and sisters.

Second question, why are we here? Trying to wrap the whole of this question into a nutshell gives us the following answer.

First, on the eternal perspective, progression requires that we each have our own physical mortal body that has the capacity of becoming refined, immortalized or glorified through the process of death and subsequently resurrection.

Second, we had to be sent somewhere outside of the presence and powerful righteous influence of God our Father to prove ourselves, to exercise our own agency, and determine in this life the nature of our life to come – the life after death. One of the prophets, Jacob, tells us that Adam & Eve were expelled out of the Garden of Eden into a “lone and dreary world” and on a probation of sorts, where a person could chose from a myriad of different things that were either good or evil. It is necessary for man to taste the bitter to enable him to appreciate the good, is one way to explain it.

The ancient prophet Alma calls this a probationary state, a time to repent, to grow, to learn responsibility, and to prepare for the next life. (Alma 12:24, 42:4)

Said the Lord, “And thus did I, the Lord God, appoint unto man in the days of his probation – that by his natural death he might be raised in immortality unto eternal life, even as many as would believe.” (Doctrine & Covenants 29:43)

Obtain a Body . . . Prove Ourselves . . . Get Experience . . . this is your first estate.

Some of us live 80 years, some of us live 50 years, some of us live 39 years, and some live only a brief few years on this earth. Will you and I be given as much time? There are laws to be learned and lived, ordinances to experience, and covenants to be made and kept, and faith and obedience to demonstrate in this life.

Third, where do we go from here? Where will I go when I die? Where have friends and family that have passed on gone to?

The penitent thief on the cross being crucified with the Savior, Jesus Christ, asked the Him the same question. The Savior responded with this answer, “Today shalt thou be with me in paradise.” (Luke 23:43)

Christ died in the literal sense that you and I will die. He underwent a physical dissolution by which His immortal spirit was separated from His body of flesh and bones, and that body was actually dead. While the corpse lay in Joseph’s rock-hewn tomb, the living Christ existed as a disembodied Spirit. Where was He?  We naturally assume that he went where spirits of the dead ordinarily go. He was in the disembodied state a Spirit among spirits. He went to the Spirit world.

We know that the spirit world is not heaven, as the Savior, on the third day after his crucifixion, met the weeping Mary Magdalene and said: “I am not yet ascended to my Father.” He had gone to Paradise as he told the penitent thief, but not to the place where God dwells. Sprit Paradise, therefore, is not Heaven, or the place where God the Eternal Father and his celestialized children dwell and make their abode. Spirit Paradise is a place where dwell
righteous and repentant disembodied spirits between bodily death and resurrection. Another division of the spirit world is reserved for those disembodied beings who have lived lives of wickedness and who remain impenitent even after death.

The ancient prophet Alma explained to his son Corianton who was confused on this matter, “Now there is must needs be a space betwixt the time of death and the time of resurrection.” (Alma 40:6) “Now concerning this state of the soul between the death and the resurrection, behold it has been made know unto me by an angel that the spirits of all men, as soon as they are departed from this mortal body, yea, the spirits of all men, whether they be good or evil, are taken home to God who gave them life. And then shall it come to pass, that the spirits of those who are righteous are received into a state of happens, which is called Paradise, a state of rest from all their troubles and from all care and sorrow.”
“And the spirits of the wicked, yea, who are evil – for behold they have no part nor portion of the Spirit of the Lord; for behold they chose evil works rather than the good; therefore, the spirit of the devil did enter into them, and take possession of their house – this is the state of the souls of the wicked, yea, in darkness, and as a state of awful, fearful looking for the fiery indignation of the wrath of God upon them; thus they remain in this state, as well as the righteous in paradise, until the time of their resurrection.” (Alma 40:11-14)

The Spirit World is therefore quite a unique place.

Another apostle and scriptural historian, Bruce R. McConkie, explains from the Savior’s parable of the rich man and Lazarus, “The spirit world is divided into two parts: Paradise which is the abode of the righteous, and hell which is the abode of the wicked. Until the death of Christ, these two spirit abodes were separated by a great gulf, with the intermingling of their respective inhabitants strictly forbidden.” (Luke 16:19-31)  We know that Christ visited this spirit world because the apostle Peter’s biblical account tells us the following: “For Christ also hath once suffered for sins, the just for the unjust, that he might bring us to God, being put to death in the flesh, but quickened by the Spirit: by which also he went and preached unto the spirits in prison; Which sometime were disobedient, when once the long-suffering of God waited in the days of Noah, while the ark was a preparing, wherein few, that is, eight souls were saved by water.” (1 Peter 3:18-20)

When Christ visited the Spirit world, he also organized the affairs of this kingdom such that the righteous spirits began teaching the His gospel to those who had not heard it and those who were disobedient or wicked.  Although, there are two spheres within the one spirit world, there is now some intermingling of the righteous and the wicked that inhabit those spheres; and when the wicked spirits repent, they leave their prison-hell and join the righteous in spirit paradise. Hence Joseph Smith said, “Hades, Sheol, paradise, spirit prison are all one: it is a world of spirits. The righteous and the wicked all go to the same world of spirits until the resurrection.” (Teachings, p. 310).

Life, work and activity all continue in the spirit world. Men and women have the same talents and intelligence there which they had in this life. They possess the same attitudes, inclinations, and feelings there which they had in this life. They believe the same things, as far as eternal truths are concerned: they continue in effect, to walk in the same path they were following in this life. (Mormon Doctrine, Spirit World, McConkie) The prophet Amulek said, “That same spirit which doth possess your bodies at the time that ye go out of this life, that same spirit will have power to possess your body in the eternal world.” (Alma 34:34) Thus, if a man has the spirit of charity and the love of truth in his heart in this life, that same spirit will possess him in the spirit world.
Family and friends who have passed away with the spirit of joviality and happiness will find it will carry them forward in the gospel and in the teaching of the gospel to many others on the other side.

When I leave this frail existence,
When I lay this mortal by,
Father, Mother, may I meet you
In your royal courts on high?
Then at length, when I’ve completed
All you sent me forth to do,
With your mutual approbation
Let me come and dwell with you.
(Eliza R. Snow, “O My Father,” Hymns, #292)

This post mortal world is a place to await resurrection. All will be resurrected. The Atonement of Jesus Christ ensures a universal resurrection. “For as in Adam all die, even so in Christ shall all be made alive.” (1 Cor 15:22) Judgment will then, after the resurrection, be passed on all according to individual works and obedience while in mortality. The great prophet Nephi says, “For by grace are they saved after all they can do.” (2 Nephi 25:23) Said the Savior to His disciples, “Yet a little while, and the world seeth me no more, but ye see me because I live and ye shall live also.” (John 14:19)

Inheriting the glory that Christ has been resurrected into is conditional and is based upon the laws by which individuals choose to govern their mortal lives.
Said the prophet Alma, “The plan of restoration is requisite with the justice of God; for it is requisite that all things should be restored to their proper order. Behold, it is requisite and just, according to the power and resurrection of Christ, that the soul of man should be restored to its body, and that every part of the body should be restored to itself.
“And it is requisite with the justice of God that men should be judged according to their works; and if their works were good in this life, and the desires of their hearts were good, that they should also as the last day, be restored unto that which is good.” (Alma 41:2-3)

The righteous who understand and live the truth will be resurrected to receive a glory in heaven referred to as Celestial and Paul refers to this as comparable to the glory of the Sun. In this celestial kingdom also known as the Kingdom of God, marriages and eternal family relationships are secured, eternal progress and progression is uninterrupted forever and ever.

The less valiant who choose the lesser law will be resurrected to receive a glory Terrestrial that Paul compares to the glory of the moon. They chose not to enjoy that which they could have enjoyed. These would not accept the words of the prophets in this life and died in their sins, but accepted afterwards.
And to the undisciplined, wicked, liars, sorcerers, adulterers, whoremongers, and the unrepentant who are shut out in spirit prison until the Savior finishes his work (D&C 76:85), they will be resurrected to a glory Telestial or that equivalent, as Paul puts it, to the “glory of the stars, for one star differeth from another star in glory.” (1 Corinthians 15:40-44)  The remainder will become attached to Perdition, those who refuse any part of the Atonement of Christ – those that are cast off forever, as the scriptures say, into outer darkness.
What of those that have taken their lives prematurely when the Lord has said, “Thou shalt not kill”? Are they consigned to spirit prison and later a telestial glory?

Another of the Lord’s modern day apostles, M. Russell Ballard, recently stated that there are “some things we know, and some we do not . . . [the] judgment for sin is not always as cut and dried as some of use seem to think. . . the Lord recognizes differences in intent and circumstances: Was the person who took his life mentally ill? Was he or she so deeply depressed as to be unbalanced or otherwise emotionally disturbed? Was the suicide a tragic, pitiful call for help that went unheeded too long or progressed faster than the victim intended? Did he or she somehow not understand the seriousness of the act? Was he or she suffering from a chemical imbalance in their system that led to despair and a loss of self control? Obviously, we do not know the full circumstances surrounding every suicide. Only the Lord knows the details, and he it is who will judge our actions here on earth.” (Liahona, March 1988, Suicide: Some Things We Know, and Some We Do Not)

Said the prophet Joseph Smith: “While one portion of the human race is judging and condemning the other without mercy, the Great Parent of the universe looks upon the whole of the human family with a fatherly care and paternal regard . . . He is a wise Lawgiver, and will judge all men, not according to the narrow contracted notions of men, but ‘according to the deeds done in the body whether they be good or evil,’ . . . We need not doubt the wisdom and intelligence of the Great Jehovah; He will award judgment or mercy to all nations according to their several deserts, their means of obtaining intelligence, the laws by which they are governed, the facilities afforded them of obtaining correct information, and His inscrutable designs in relations to the human family; and when the designs of God shall be made manifest, and the curtain of futurity be withdrawn, we shall all of us eventually have to confess that the Judge of all the earth has done right.” (Teachings of the Prophet Joseph Smith, Salt Lake City, Deseret Book, 1938, p218)

When we are judged, the Lord will take all things into consideration: our genetic and chemical makeup, our mental state, our intellectual capacity, the teachings we have received the traditions of our fathers, our health, and so forth.

That is the plan. Those are the answers. Death, then, is a gateway.

Upon the cross he meekly died
For all mankind to see
That death unlocks the passageway
Into eternity.
(Hymns, #184 – “Upon the Cross of Calvary”)

“The keeper of the gate is the Holy One of Israel; and he employeth no servant there; and there is none other way save it be by the gate; for he cannot be deceived, for the Lord God is his name.” (2 Nephi 9:41)

To live, to love, and to be loved are the essence of what is important in this life.  Those we have known and passed on have lived great lives, they were loved and are still loved.

Mourning and tears are normal – in fact, they are a healthy reaction. Mourning is one of the purest expressions of deep love. It is a natural response in accord with divine commandment: “Thou shalt live together in love, insomuch that thou shalt weep for the loss of them that die.” (D&C 42:45)

By mortal standard time, it’ll be much longer than we like till we see our loved ones again. By eternal standard time – “We’ll see you soon.”

Until then watch. There are another set of hands you should look for, pierced at the palms and at the wrists. You will recognize His hands when you see them. You will recognize Him when you see Him. His hands are always open. The brightness of His eyes and smile will warm the darkest recesses of your soul. When you meet Him, touch his hands, feel the mark in his side, and bow at His feet. He knows you by name. He knows each of us by name. He will offer you the peace, the rest and the love that you seek.

“To everything there is a season, and a time to every purpose under heaven: A time to be born and a time to die . . . A time to weep, and a time to laugh, at time to mourn, and a time to dance . . . a time to get and a time to loose . . . a time to embrace . . . and a time to love.” (Ecclesiastes 3:1-8)

This death of which I speak eventually comes to all. It comes to some in childhood, to some in ripe old age, and to others in the prime of life. To some it comes by natural means, anticipated and expected, to others it comes without warning, unannounced. It may come quietly in the peace of the night, or it may come violently in the confusion of an instant, but assuredly, it comes to all.

To you my beloved friends, patients and family, remember His invitation.  “Come unto me, all ye that labor and are heavy laden, and I will give you rest. Take my yoke upon you, and learn of me; for I am meek and lowly in heart; and ye shall find rest unto your souls. For my yoke is easy, and my burden is light.” (Matthew 11:28-30)

This yoke is a conviction, a way of life; it is called the Gospel of Jesus Christ. It does not take away challenges, disappointments, frustrations, pain or sorrow. But, when lived, it lifts burdens, lightens loads, and makes life bearable. It empowers you with light and strength from on high to learn and grow from experiences in spite of whatever life brings.

This is my conviction. This I know to be true. It is what brings hope in the battle against the inevitable foe, death. May it bring you the warmth of heart and the solace of soul that it brings to me as I ponder its meaning in my life and the lives of my family. May the knowledge of the Plan of Salvation bring you comfort in knowing that those we care about have passed through the gateway we call death to look forward upon immortality and the Glory of the Savior Jesus Christ.

Stress . . . . The Weight Loss Killer

Has your weight loss plateaued? Are you struggling to meet your weight loss goals? Have you struggled to lose weight in spite of doing everything “correctly?” Are you still struggling with those last few pounds?

You’re not alone. Many of my patients, myself included, have found themselves “stuck” in their weight loss progression.  There are a number of reasons you may not be loosing weight, but one that I am seeing more and more frequently is “Pseudo-Cushings’s Syndrome.Pseudo-Cushing’s Syndrome is a physiologic
hypercortisolism (high level of cortisol) that can be caused by a number of problems:

  1. Physical stress
  2. Severe bacterial or fungal infection
  3. Malnutrition or Intense chronic exercise
  4. Psychological stress – including untreated or under-treated depression, anxiety, post-traumatic stress, or dysthymia (chronic melancholy)
  5. Alcoholism

The psychiatric literature suggest that up to 80% of people with depressive disorders have increased cortisol secretion (1,2,3).  HPA Stress responsePeople with significant stressors in their life have been show to have a raised cortisol secretion. Chronic stress induces hyperactivity of the hypothalamic-pituitary-adrenal axis causing an over production of cortisol and normalization of their cortisol levels occurs after resolution of the stressor.  This cortisol response is not high enough to lead to a true Cushing’s Syndrome, but effects ones ability to loose weight.

I suspect this is becoming more prevalent due to the high paced, high-stress, always on, plugged in, 24 hour information overload lives we live.

What is cortisol? It is a steroid hormone made naturally in the body by the adrenal cortex (outer portion of the adrenal gland). Cortisol is normally stimulated by a number of daily activities including fasting, awakening from sleep, exercise, and normal stresses upon the body. Cortisol release is highest in the morning, helping to wake us up, and tapers into the afternoon. Cortisol plays a very important role in helping our bodies to regulate the correct type (carbohydrate, fat, or protein) and amount of fuel to meet the bodies physiologic demands that are placed upon it at a given time (4,5,6).

HPAThyroidUnder a stress response, cortisol turns on gluconeogensis in the liver (the conversion of amino acids into glucose) for fuel. Cortisol, also, shifts the storage of fats into the deeper abdominal tissues and turns on the maturation process of adipocytes (fat cells). In the process, it suppresses the immune system to decrease inflammation during times of stress (7,8,9).  In the short run, this is an important process, however, when cortisol production is chronically turned up, it leads to abnormal deposition of fat, increased risk of infection, impotence, abnormal blood sugars, head
aches, hypertension and ankle edema, to name a few.

The chronic elevation in cortisol directly stimulates an increase in insulin by increasing the production of glucose in the body, and cortisol blockaids the thyroid axis. Both of these actions halt the ability to loose weight, and drive weight gain.
Cortisol also increases appetite (10).  That’s why many people get significant food cravings when they are under stress (“stress eaters”). Cortisol also indirectly affects the other neuro-hormones of the brain including CRH (corticotrophin releasing hormone), leptin, and neuropeptide Y (NPY). High levels of NPY and CRH and reduced levels of leptin have also been shown to stimulate appetite (10-11).

How do you test for Pseudo-Cushing’s Disease?  

Testing can be done by your doctor with a simple morning blood test for cortisol. If your cortisol is found to be elevated, it needs to be repeated with an additional 24 hour urine cortisol measurement to confirm the diagnosis. If Cushing’s Syndrome is suspected, some additional blood testing and diagnostic imaging will be necessary.

How do you treat it?

First, the stressor must be identified and removed.  Are you getting enough sleep?  Is there an underlying infection? Is there untreated anxiety or depression present?  Are you over-exercising? These things must be addressed.

Second, underlying depression or anxiety can be treated with counseling, a variety of weight neutral anti-depressant medications or a combination of both.  Many of my patients find that meditation, prayer, and journaling are tremendous helps to overcoming much of the anxiety and depression they experience.

Third, adequate sleep is essential.  Remove the television, computer, cell phone, iPad or other electronic distraction from the bedroom.  Go to bed at the same time and get up at the same time each day. Give yourself time each day away from being plugged in, logged in or on-line.

Fourth, mild intensity (40% of your maximal exertion level) exercise 2-3 days a week was found to lower cortisol; however, moderate intensity (60% of your maximal exertion level) to high intensity (80% of your maximal exertion level) exercise was found to raise it (12).  A simple 20 minute walk, 2-3 times per week is very effective.

So, the take home message . . . It’s not the stress that’s killing us, it’s our reaction to it.

References:

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  3. Gold PW, Loriaux DL, Roy A, et al. Responses to corticotropin-releasing hormone in the hypercortisolism of depression and Cushing’s disease. Pathophysiologic and diagnostic implications. N Engl J Med 1986; 314:1329.
  4. Ely, D.L. Organization of cardiovascular and neurohumoral responses to stress: implications for health and disease. Annals of the New York Academy of Sciences (Reprinted from Stress) 771:594-608, 1995.
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  7. Wallerius, S., R. Rosmond, T. Ljung, et al. Rise in morning saliva cortisol is associated with abdominal obesity in men: a preliminary report. Journal of Endocrinology Investigation 26: 616-619, 2003.
  8. Epel, E.S., B. McEwen, T. Seeman, et al. Stress and body shape: stress-induced cortisol secretion is consistently greater among women with central fat.
    Psychosomatic Medicine 62:623-632, 2000.
  9. Tomlinson, J.W. & P.M. Stewart. The functional consequences of 11_- hydroxysteroid dehydrogenase expression in adipose tissue. Hormone and Metabolism Research 34: 746-751, 2002.
  10. Epel, E., R. Lapidus, B. McEwen, et al. Stress may add bite to appetite in women: a laboratory study of stress-induced cortisol and eating behavior.Psychoneuroendocrinology 26: 37-49, 2001.
  11. Cavagnini, F., M. Croci, P. Putignano, et al. Glucocorticoids and neuroendocrine function. International Journal of Obesity 24: S77-S79, 2000.
  12. Hill EE, Zack E, Battaglini C, Viru M, Vuru A, Hackney AC. Exercise and circulating cortisol levels: the intensity threshold effect. J Endocrinol Invest. 2008. Jul;31(7):587-91.